Sphenoid Wing Drilling

'Sphenoid wing drilling' is a critical step in skull base and vascular neurosurgery, particularly during pterional or orbitozygomatic craniotomies. It involves the removal of the sphenoid ridge to flatten the skull base and improve surgical access to deep intracranial structures.

Definition

Sphenoid wing drilling refers to the removal of the bony ridge formed by the greater and lesser wings of the sphenoid bone, using a high-speed drill under microscopic visualization.

Purpose

Surgical Steps

  1. After performing the craniotomy (e.g., pterional), identify the sphenoid ridge anterior to the temporal lobe.
  2. Use a cutting burr to remove the outer cortical bone.
  3. Proceed with a diamond burr to thin and smooth the bone over the superior orbital fissure and anterior clinoid.
  4. Careful attention is required to avoid:
    1. Injury to the orbit medially
    2. Dural tears and CSF leaks
    3. Damage to frontal sinus or optic canal

Anatomical Considerations

Risks

Notes